For healthcare organizations, preventive measures designed to reduce and eliminate disease transmission occurring within a facility are critical components
of patient safety. According to the Centers for Disease Control & Prevention, almost 1.7 million 1 hospital-acquired infections (HAIs) occur
annually, and approximately 99,0002 deaths each
year are attributable to HAIs. Further, the Department of Health & Human Services estimates that HAIs are responsible for $28 to $33 billion dollars 3 in preventable healthcare expenditures each
year.

For the Veterans Health Administration (VA)—one of the largest healthcare systems in the country, providing care to over 8.7 million Veterans 4in 300 VA hospitals and 827 5 community-based outpatient clinics—prevention of HAIs is a priority. Within VA's Office of Public Health, the National Center for Occupational Health and Infection Control focuses on providing evidence-based guidance about preventing and responding to HAIs. To support those efforts, investigators within VA's Health Services Research & Development Service (HSR&D) conduct a variety of research studies focused on detecting and preventing HAIs. The following include just a few of these ongoing investigations.

Evaluation of a Pulsed-Xenon Ultraviolet Room Disinfection Device.
Each year, there are approximately 8,000 patient admissions and transfers within the facilities comprising the Central Texas Veterans Health Care
System, and each admission or transfer necessitates the intensive cleaning and disinfection of patient rooms. Previous research has shown that manual
cleaning that focuses on visible, soiled areas misses 70% of high-touch surfaces. Portable machines emitting pulsed xenon ultraviolet rays (PX-UV),
however, effectively kill many microbial pathogens with shorter cleaning times, yielding a practical, less expensive option for routine room
disinfection. This study, slated to conclude in 2016, will examine both the clinical and economic benefits of PX-UV decontamination of post-discharge
patient rooms.

Improving Practice: Automated Compliance Monitoring in Infection Control.
In 2007, VA began a national initiative to reduce the spread of methicillin-resistant Staphylococcus aureus (MRSA). Part of that initiative's success
depends on healthcare workers' compliance with hand-hygiene and contact precautions (i.e., hand washing, gowns and gloves worn when entering patient
rooms). There are two factors that influence compliance: continuous monitoring of compliance, and direct feedback of compliance rates to healthcare
workers. However, direct observation of hand hygiene and gown/glove use are problematic. This study, slated to conclude in December 2013, sought to
measure monthly compliance with hand hygiene and glove/gown use; assess risk factors; provide sustained feedback of estimated compliance; and determine
if contact isolation modifies or improves healthcare worker behavior, including hand hygiene.

Using Economics and Epidemiology to Evaluate MRSA Decolonization in VA.
Treating infectious diseases like methicillin-resistant Staphylococcus aureus (MRSA) can produce spillover effects that impact individuals who are not
currently infected. This five-year study (part of HSR&D's Career Development Award
program) seeks to evaluate the impact that MRSA has on health care cost and utilization by examining facility-level elimination of MRSA and MRSA infection
rates, as well as the impact of MRSA infections on length of inpatient stay and post-discharge costs.